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Ambassador Interest Form
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What is your first name?
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What is your last name?
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Please provide your email:
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Please provide a phone number to reach you:
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What university, institute or organization are you associated with?
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Please provide a link to your university department, institute or organization website:
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What is the nature of your involvement or interest in Planetary Defense?
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In 500 words tell us why you would like to be an ambassador and what specific connections you have to students in the region:
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